Provider Demographics
NPI:1295895332
Name:MANZANO, DEBORAH (PSY D)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:
Last Name:MANZANO
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 EAST ST
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:CT
Mailing Address - Zip Code:06248-1346
Mailing Address - Country:US
Mailing Address - Phone:860-266-7759
Mailing Address - Fax:860-797-2430
Practice Address - Street 1:121 EAST ST
Practice Address - Street 2:
Practice Address - City:HEBRON
Practice Address - State:CT
Practice Address - Zip Code:06248-1346
Practice Address - Country:US
Practice Address - Phone:860-266-7759
Practice Address - Fax:860-797-2430
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3470103TC0700X
MA8301103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA5150001Medicare PIN